**7.4 Testing of children for type 2 diabetes mellitus**

Until recently, type 1 diabetes was the most frequent form of diabetes among young people [80]. Recently however, there are increasing reports of T2DM, previously a disorder of middle-aged or elderly persons among children and adolescents. In the 1990s, various reports indicated that the incidence of childhood type 2 diabetes was increasing and this trend continues at present. The ADA and the American Academic of Paediatrics approved screening for T2DM in children because T2DM can be asymptomatic at diagnosis and requires tight glycaemic control to delay the onset of chronic vascular complications. Several studies have shown an increased risk of microvascular complications among young adolescents with T2DM compared to those with T1DM. Therefore, screening for IGT and T2DM in children at risk of glucose intolerance is necessary.

non-GDM pregnancies, plasma glucose levels during late pregnancy (mean 1 SD) were noted to be fasting 3.9 0.4 mmol/L, 1 hour postprandial 6.1 0.7 mmol/L, and 2 hours postprandial 5.5 0.6 mmol/L with a mean glucose of 4.9 0.6 mmol/ L [82]**.** The HAPO study reported a mean fasting glucose of 4.5 0.4 mmol/L, derived from 23316 pregnant women [38]. But women with diabetes or those who have tendency to develop GDM, endogenous insulin secretion is inadequate to compensate for the insulin resistance (IR), hence their hyperglycaemia worsen or

*Oral Glucose Tolerance Test (OGTT): Undeniably the First Choice Investigation…*

Numerous factors such as placental hormones, obesity, inactivity, an unhealthy diet, genetic and epigenetic contributions influence IR in pregnancy, but the causal mechanisms are complex and still not completely elucidated [83]. Placental derived hormones are believed to be a major factor in reprogramming maternal physiology to achieve an I-R state. Human placental lactogen (hPL) and human placental growth hormone (hPGH) are the major player in pregnancy induced IR [84]. Prolactin, progesterone, estradiol and cortisol are increased during pregnancy and may contribute to the development of IR in pregnancy [85]**.** Recently, studies have implicated adiponectin from adipocytes and secreted factors, such as TNF-α, leptin, IL-6, resistin in mediating IR of pregnancy [86]. Most women who develop GDM have increased IR caused by alteration in insulin signaling pathway, abnormal subcellular localization of GLUT4 transporters, increased expression of the membrane glycoprotein PC-1 or reduced insulin-mediated glucose transport. GDM is usually diagnosed after 20 weeks' gestation when placental hormones are increase

In 2014, the WHO has defined hyperglycaemia in pregnancy (HIP) as diabetes first detected at any time during pregnancy, along with pre-existing diabetes and is further sub-classified as diabetes in pregnancy (DIP) and gestational diabetes mellitus (GDM**)** [87]**.** Nowadays type 2 diabetes is frequently found in young women due to ongoing epidemics of obesity therefore the number of undiagnosed (before pregnancy) is increasing. Screening for GDM earlier than 24-28 weeks in identifying these young women and address perinatal risks that may be particular to their greater degree of hyperglycaemia is becoming more important because of the

they development hyperglycaemia.

*DOI: http://dx.doi.org/10.5772/intechopen.96549*

substantially as the placental size increases.

1.Rise chances of congenital malformations in offsprings

2.Risk of diabetes complications requiring treatment during early part

3.Early treatment Prompt or frequent follow-up to maintain normoglycaemia

How then do we identify these women? Early glucose testing is important. Usually in early part of pregnancy (e.g. first trimester and first half of second trimester) fasting and postprandial glucose concentrations are normally lower than in normal due to less effect of placental hormone and decreased appetite, compared to non–diabetes women. Elevated fasting or postprandial plasma glucose levels at this time in pregnancy may reflect diabetes antedating pregnancy. In this regards there was a uniform agreement during IADPSG Pasadena meeting that this assessment should be made during the initial visit for prenatal care. However, there is variability in time of enrollment for prenatal care beyond the control of health care providers. Accordingly, no limit can be place on the timing of initial assessment for

4.Post-pregnancy screening ensuring confirmation and appropriate treatment of

following [87]:

**131**

pregnancy

diabetes after pregnancy
